AccountId: 011433970860
ContactId: b606e352-009d-4083-9f8f-2c60a42eb5e9
Channel: VOICE
LanguageCode: en-US
Total Conversation Duration: 406170 ms
Total Talk Time (AGENT): 121927 ms
Total Talk Time (CUSTOMER): 227971 ms
Interruptions: 0
Overall Sentiment: AGENT=2, CUSTOMER=0.5
Redaction Types: PII
Input Audio S3: s3://apl-connect-contactcenter-data-prod/connect/apl-prod/CallRecordings/2025/06/19/b606e352-009d-4083-9f8f-2c60a42eb5e9_20250619T19:22_UTC.wav
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[AGENT][NEUTRAL] Thank you for calling APL. This is [PII]. How can I help you?
[CUSTOMER][NEUTRAL] Hi, [PII], my name is [PII].
[CUSTOMER][NEUTRAL] And I need to find out I've received some bills that I am really not familiar with. We have APL through my husband's employer.
[CUSTOMER][NEUTRAL] And I just need some assistance to know what's covered and what isn't. It's a meddling with benefit assignment, so I am not sure.
[CUSTOMER][POSITIVE] Exactly what that totally entails.
[AGENT][NEUTRAL] Um, yes, ma'am. I can assist you. Um, first, could I get your name again and a good callback number just in case we're disconnected?
[CUSTOMER][NEUTRAL] Sure. It's [PII] and the last name is [PII], [PII]
[CUSTOMER][NEUTRAL] And my phone number is [PII].
[AGENT][POSITIVE] OK, thank
[AGENT][NEUTRAL] Mhm.
[AGENT][NEUTRAL] OK. Thank you, [PII]. Now I need your policy number. Um, it'll be the outpatient certificate number on the card.
[CUSTOMER][NEUTRAL] It's 01897873.
[AGENT][NEUTRAL] Thank you. Now, please verify your date of birth and your mailing address.
[CUSTOMER][NEUTRAL] [PII] [PII].
[AGENT][POSITIVE] OK, thank you.
[AGENT][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] I'm gonna take you off speaker until I have to write something down that way everybody always says that my phone cuts out. I apologize.
[AGENT][POSITIVE] Oh, no problem.
[CUSTOMER][NEUTRAL] OK
[AGENT][NEUTRAL] OK. Yes, ma'am. Under this policy, what we do is cover the co-pay, the co-insurance, and the deductible for coverage services, um, up to a certain amount after the primary insurance processes the claim. Um, what type of services are you calling about? What are you receiving bills for?
[CUSTOMER][NEUTRAL] Well, I'm gonna have copays so we just found out that I have a melanoma and it's spread.
[AGENT][POSITIVE] I'm sorry to hear that.
[CUSTOMER][NEUTRAL] So one of the doctor's offices, one of the doctor's offices sent me a note back saying that I had a balance because I thought when I talked to someone a few weeks ago, she's like, you know, anything to do with like any testing or
[CUSTOMER][NEUTRAL] So a couple of years ago, I had a whole bunch of stuff done, but then my husband said I was working at that time, and he took me off his insurance and that.
[CUSTOMER][NEUTRAL] So I kind of found out a little bit about it, but I didn't have to worry about it because
[CUSTOMER][NEUTRAL] I didn't have to do anything with it. So I just forgot about it. So now that I'm in the war zone, I need to find out what we're going to end up getting hit with. And I apologize. I don't mean for it to sound like that, but, you know, I'm just kind of at a loss of what's going on. But the doctor's offices sent me a bill.
[CUSTOMER][NEUTRAL] In the hospital for the preoperative testing before I had surgery.
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] And then another lab or something before, and I said, have you send it to APL to make sure, you know, that they'd take care of it. And so I've talked to them numerous times. And so,
[CUSTOMER][NEUTRAL] You know, I, I, if I'm telling them to do something, I wanna make sure that I'm incorrect um telling them what to do and what's gonna be covered or what isn't.
[CUSTOMER][NEUTRAL] Let me look real quick um.
[AGENT][NEUTRAL] Yes, ma'am, cause so far.
[CUSTOMER][NEUTRAL] Because they.
[AGENT][NEUTRAL] Yeah, they haven't billed us anything yet. We haven't received any claims. I'm showing the last claims on file for you were back in [PII].
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] Yeah.
[CUSTOMER][NEUTRAL] So,
[CUSTOMER][NEUTRAL] Should I be paying their copays when I'm in their office? Are copays covered?
[AGENT][NEUTRAL] Um, yes, ma'am, for.
[CUSTOMER][NEUTRAL] For office visits?
[AGENT][NEUTRAL] For cancer treatment, for services that are um related to cancer treatment, um, it is covered. But for any other services in the provider's office, in the doctor's office, the co-pay is not covered, but we do cover the co-insurance and the deductible and we cover that up to $3500 per calendar year.
[CUSTOMER][NEUTRAL] OK.
[AGENT][NEUTRAL] Yeah, so I'm showing that there is coverage. They just need to file the claims and of course if they don't file the claim, then you can file claims yourself.
[CUSTOMER][NEGATIVE] Yeah, OK, I just, I just don't know why they're not sending it and they're just.
[CUSTOMER][NEUTRAL] It is crazy. OK. So, um,
[CUSTOMER][NEUTRAL] What about
[CUSTOMER][NEUTRAL] A co-pay when I went to the dermatologist because
[CUSTOMER][NEUTRAL] They weren't sure what it was but it ended up turning out to be a melanoma.
[CUSTOMER][NEUTRAL] For that office visit when all this first started back at the beginning of May.
[AGENT][NEUTRAL] OK. Yes, it wasn't for cancer treatment and they wasn't sure then that pro that wouldn't be covered. No, ma'am. Cause we'll go by the diagnosis code.
[CUSTOMER][NEUTRAL] So I went
[CUSTOMER][NEUTRAL] OK, that's what I wanted to make sure.
[CUSTOMER][POSITIVE] OK, perfect.
[CUSTOMER][POSITIVE] Alright, well you've answered all my questions that that you know, from here on out.
[CUSTOMER][NEUTRAL] I just make sure that they send it to you before we start paying on anything.
[AGENT][POSITIVE] Yes, ma'am. That sounds like a good plan. Is there anything else I can assist you with?
[CUSTOMER][NEGATIVE] No, so you guys only pay the $3500 deductible and after that you guys pay nothing, nothing in the out of pocket expenses also.
[AGENT][NEUTRAL] For outpatient services, yes, ma'am, we cover up to 3500 per calendar year and it's the same for inpatient services. It's a separate 3500 we pay if you're ever admitted.
[AGENT][NEUTRAL] And that's again for the co-pay, the co-insurance, and the deductible.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][NEUTRAL] So we've got
[AGENT][NEUTRAL] Mhm.
[CUSTOMER][NEUTRAL] A co-insurance amount of $6000 so you guys will cover the.
[CUSTOMER][NEUTRAL] The 3500 and then after that that the rest will be ours, correct? That's what I'm thinking.
[AGENT][POSITIVE] Yes, ma'am. Yes, that's correct.
[CUSTOMER][NEUTRAL] OK.
[CUSTOMER][POSITIVE] Alright, great, thanks Ay for your time I appreciate you answering my call.
[AGENT][POSITIVE] OK, thank you, [PII], for calling APL. You have a great rest of your day. Bye.
[CUSTOMER][POSITIVE] Thank you. Bye-bye.
[AGENT][POSITIVE] Thanks.